Monday, January 27, 2014

12 Steps to Defeat Depression: Cognitive Behavior Therapy, and Laughter

            Cognitive behavior therapy, also known as CBT, is what is referred to as a type of psychotherapeutic treatment aimed at helping patients first recognize the thoughts and feelings they have in response to any given situation, and then helping them understand those thoughts and feelings, and answer why they might be experiencing them. It’s commonly used to treat a range of disorders, including depression and anxiety.
            CBT is usually a short-term therapy focused on helping people focus on and correct a specific problem. You’re taught how to identify your destructive behavior or thought patterns and then learn alternative behaviors or responses.

            The idea behind CBT, which is supported by brain research, is that our feelings play an influential role in how we behave. As I covered in earlier blogs, feelings trigger neurochemical responses, which then trigger behavior. As this behavior becomes a “learned response,” the area in the brain responsible for remembering the response dumps chemicals into the system that once again causes a triggering of the response. It becomes a vicious cycle that’s difficult to break.

            Notice I said difficult, not impossible. *
            A CBT patient discovers that while they will never be able to completely control their environment, it is possible for them to control how they interpret those surroundings and respond to them. Like my elevator story I relayed several blogs ago, just thinking about getting in an elevator caused my fear level to rise, which caused the fight or flight chemicals to dump into my system, which, in turn, caused my heart rate and breathing to escalate to panic level. I fed this panic by mentally entertaining all of the awful things that could happen to me if I got stuck in an elevator. It was like a rolling snowball, gathering more and more snow until it became a behemoth I couldn’t control or stop.

            The CBT treatment process usually begins with the functional analysis stage, when the therapist helps the patient identify their problematic beliefs. The patient learns how their thoughts, feelings, and situations can contribute to destructive behaviors. This first process can be difficult, especially for those patients uncomfortable with contemplating their personal thoughts, feelings and physical sensations. In other words: the people who don’t like self-examination.

            But the self-discovery it can lead to can open up insights critical to the healing process.

            The second part of CBT concentrates on the behaviors that correspond to the perceptions, feelings or sensations. It is the behaviors that are the major culprits: you feel depressed, so you eat. You feel inadequate, so you don’t attempt activities in which you feel you’d fail, or you avoid social situations and opportunities that might provide advancement or personal enjoyment.

            Once you’ve identified the negative behaviors, the therapist teaches you new behaviors that you practice. And the more you practice, the more likely you are to be able to change your brain’s learned response to the original trigger! You take baby steps toward a larger goal, and your brain follows suit.

            CBT is focused on highly specific goals and has been used to successfully treat a variety of disorders, including depression, anxiety, phobias and addiction. In my most recent neuroscience course, our instructor said that a person suffering from depression should not be taking anti-depressant medication without also undergoing cognitive behavior therapy. He indicated that while the medications could take the edge off, it was the therapy that provided the real healing. He gave me the impression that he thought CBT alone could do the job, and should be the first line of treatment, especially when the negative side effects of anti-depressant medications are considered.

            If you want to give CBT a try, you must be ready and willing to spend time analyzing your thoughts and feelings. You must be open to better understanding yourself, which may initially cause you some hurt and disillusionment. Later, it will bring you a sense of relief and empowerment.

            However, you must understand that undergoing this therapy and becoming more aware of your feelings will not necessarily stop you from having them. It is your response to them—the behavior—you need to change.

            There are, however, techniques employed to help you overcome or subdue these feelings and thoughts. We’ve covered many of them in this blog. They include relaxation techniques, meditation, mindfulness, guided imagery and biofeedback. To those you can add journaling, role-playing and mental distractions.

            But, truly, the only thing that will help you change your feelings will be drawing closer to Jesus. The closer you get to Him, the better able you are to see things clearly—as they truly are—and the more likely you will be to respond to your situations with positive, life-affirming feelings and a sense of control and peace.

            The final advice I can give you is to fill your life with laughter. Hardly anything else does so much good for the body and spirit as a good laugh, a smile, a chuckle. As the Bible says, a merry heart is good medicine! And 21st Century medical research verifies that centuries-old wisdom. It strengthens your immunity, provides a physical and emotional release when you are stressed, and provides you with improved happiness.

            It lightens whatever load you’re carrying and causes your face—and heart—to smile. And medical research shows that just the act of moving your facial muscles into the motion of laughter, causes endorphins to be released into the system. Yes, those feel-good brain chemicals start running around the body, acting like a morphine drug! Laughter, even just the facial muscle movement mimicking it, really is good medicine!

            God’s marvelous word is relevant for our lives today. Science is just now validating its age-old truths!

            Well, this brings us to the end of our journey through defeating depression. I hope you’ve learned some effective coping skills and lifestyle changes that have encouraged and helped you. It has been an honor to go on this journey with you. My prayer is that all of you recover and stay healthy, happy and well and can face each new day with more joy and peace than you did the last!

             I pray that you find hope in your future, regardless of where pain and grief have led you.


NEXT WEEK: I begin to fully recover from depression and return to life, and then face the haunting questions: Where do we go from here; and, Do we try again and take a calculated risk in pregnancy—my life and the life of my unborn child…

Until next week,

Thanks for joining me!



* PTSD is one condition that does not seem to respond well to cognitive behavior therapy.

Monday, January 20, 2014

12 Steps to Defeat Depression: Manual Therapy

            And behold, a leper came and worshipped [Jesus], saying, “Lord, if You are willing, You can make me clean.”
         Then Jesus put out His hand and touched him, saying, “I am wiling; be cleansed.” Immediately his leprosy was cleansed.
                                                                         ~ Matthew 8:2-3
            Reread the above verses. Can you imagine it? Having leprosy? Being grossly disfigured and outcast from your friends, your family, from all of society?  
            Can you imagine not being touched for years, because it wasn’t allowed; and because—being afraid they’d contract the disease from you—no one wanted to touch you? To tenderly pat your back, lovingly stroke your arm. Wrap their arms around you in a hug?
            Since touch is one of my primary love languages of communication, I can’t imagine not being touched by my husband, my children, my family, my friends. I honestly think I’d shrivel up and die if I couldn’t experience the touch of another person.
            Reread the passage again, and notice what Jesus does. In other leper healings recounted in Scripture, He simply speaks and the lepers are healed. But in this situation, Jesus touches. He violates the rules and lays His hand upon this desperate, dying person.
            Can you imagine what being touched felt like to this man who probably hadn’t felt another human being's warm gentle hand in weeks, months, possibly years?
            Jesus always meets us where we are, providing our greatest needs. And in this situation, Jesus knows that this emotionally and physically starved man needed to be touched.
            Maybe that’s exactly what you need today: a loving touch, a hands-on therapy.
            Manual therapies, like massage and muscle manipulation, have been around for thousands of years, and they are some of the most commonly used group of treatments in the world today. There’s just nothing quite like what we always referred to as “the laying on of hands.”
            Whether it’s the sensation one feels when touched, the warmth of the touch, the tenderness of it, or the actual detoxification and healing one receives after a good massage, I believe manual therapy is one of the best ways to increase blood flow to the tissues, lift one’s spirit, and produce healing in the body and mind.
             People often asked me if manual therapy or massage works. My response was always, “Well, I think it does, but even if we can’t actually get solid data proving that it does, as long as it doesn’t cause the patient harm, and they think it’s beneficial, then I’m all for it!” There’s just something beneficial to the brain when you believe the treatment you’re receiving is working.

What is Manual Therapy?
            Physical forces applied to the body define hands-on treatments—otherwise referred to as manual therapies. They can include massage, manipulation and mobilization. The most common side effect is local tenderness, which usually resolves itself rapidly after the treatment, unless your therapist has been especially vigorous and overdone it.
            Here are some of the most popular therapies available:

Alexander Technique:
Named for an Australian-English actor, this technique teaches you to become more aware of your posture and body movements and is used to relieve pain improve body function and prevent injury. Its effectiveness has not been well-documented, but if your depression stems from physical issues, then you might do some research on it, find a practitioner in your area, and give it try.

Feldenkrais Method:
This treatment was actually coming into vogue 24 years ago, when I was still doing clinic work. It uses gentle movements and body awareness exercises (some of which are difficult only to the extent that they’re hard to get used to and require a lot of body awareness to perform correctly) to develop increased flexibility and coordination. I’m not sure about the increased flexibility, but it does increase your coordination by increasing your body awareness and quality of movement. It does that through continual body feedback during your exercises you perform with a trained therapist. The exercises are done sitting, lying down or standing and progress in range and complexity. It has been used to treat anxiety and depression, and may be successful in these areas because of the attention it gives to body awareness and control.

I can’t say enough good things about massage therapy, but you must have someone who is trained in it in order to reap the benefits. During massage, the therapist manipulates the body’s soft tissues—gently or vigorously—using either their fingertips, hands or fists. (Yes, fists.) They may even do some patting, pounding, pulling, or pinching, depending upon the type of massage.

A massage may make you feel relaxed, but it can also get your blood flowing vigorously and liven you up. Swimmers—who have been some of the frontrunner athletes in using massage in their training and competition—have used it for years to get them loose and charged for a race. Be careful, though. Vigorous massage can hurt you, so make sure your therapist knows exactly what your physical and mental issues are so they can massage accordingly.

A not-so-funny story about an experience I had right out of grad school in my first job highlights my caution. 

The physical therapists I worked for had just attended a conference where they learned a brand new, wonder therapy. Well, they had what we call an “in service” event, where the staff gathered to learn this new, must-know treatment. And guess who they selected as the guinea pig? You got it! Moi. Me; the newbie.

Anyway, the therapist (my boss) demonstrating got real vigorous with the myofascial release and Rolfing (deep tissue massage ) technique he’d just learned, that he was demonstrating on my sternocleidomastoid muscle (the big one that runs from your collarbone and breastbone, and then up and around your neck to the base of your skull). As he pulled, stretched and attempted to separate the muscle from the "tight" connective tissue (or loosen its connection, which, in turn was to give me, the "patient," more flexibility and range of head and neck motion), my neck started getting pretty sore. 

Unfortunately, I didn’t have enough guts to tell my boss to lighten up, but I should have. Upon awakening the following morning, my muscle was so swollen that it put pressure on my airway and caused me considerable breathing difficulty. My lymph glands were swollen to the size of grapes, and my throat was sore and nearly closed.

So, find someone who’s had experience with the different techniques, and don’t hesitate to alert your therapist if they’re causing you pain. It doesn’t always have to be painful to provide effective healing. (Although sometimes rehabilitation can and does cause a patient considerable discomfort.) Most often though, the guideline is for gentle manipulation.

Massage is highly effective for people suffering from stress, anxiety and depression, regardless of the cause. So it’s way up there on my list of favorite therapies. And it has also been shown to increase the strength of the immune system, which means your body is more likely to be able to defend itself against viral and cancer cells.

That wraps up manual therapies. You can probably think of others to add to this list, but I’ve concentrated on those treatments most likely to help you in your battle with depression, grief-driven or otherwise. You may have some you would like to share with all of the readers. Please leave a response so we can add them to the list!


NEXT WEEK: We’ll be wrapping up this series on depression with cognitive behavioral
therapy and some additional spirit and mood-lifting activities! Then I’ll return to my story, which also covers high-risk pregnancies and premature infants. You’ll be both encouraged and amazed.

So, until next week,

Thanks for joining me!





Monday, January 13, 2014

12 Steps to Defeat Depression: Spirituality and Prayer Part 4

…always pursue what is good both for yourselves and for all. Rejoice always, pray without ceasing, in everything give thanks; for this is the will of God in Christ Jesus for you. 1 Thessalonians 5:14-18
            So how, exactly, do these verses—and this advice—help you if you’re suffering from depression, especially grief-driven depression?
            At first glance, you may react immediately by saying, “I can’t do those. Rejoice? Give thanks in everything? And then you’ll probably add, “And how can this be God’s will, to rejoice in this pain, to give thanks in my loss? It’s impossible, and I don’t even think it’s right.”
            I can understand those feelings, and I’ll admit it’s difficult for me to respond in the manner laid out in these verses. I’ve found that it takes perseverance, discipline and a complete change of heart and mind to put these into practice.
            But I’ve also found that when I do respond this way—and sometimes it takes a monumental effort on my part to do so, to war with my flesh and mind and wrestle them into submission over this—it provides me with healing and peace I can’t begin to describe. Healing and peace that burrows deep into my soul and heart, that causes an immediate change of attitude and outlook on my circumstances and on my life.
            Paul knew what he was doing when he instructed everyone to practice these behaviors because he knew it’s good for you to do it. It’s good for your mind! And what’s good for your mind is usually good for your body, soul and overall health.
            So let’s go through each of them. They’re pretty basic and won’t take much time to cover.
            Rejoice always!
            Hmmm. Really!? You can’t be serious! Oh, I can assure you he is. Rejoice. Always. Even when you don’t feel like rejoicing. Like love, rejoicing is an action, and often, when you start acting in a loving way, your mind and body follow along for the ride. And so it is with rejoicing. When you raise your hands in praise and happiness and change your speech to positive words, and force yourself to think good, rejoicing thoughts, your mind responds. (Remember the cognitive-behavioral therapy I referred to several posts ago?)
            Your mind will trigger a release of endorphins and feel-good hormones to bring your thoughts, mind and body into line with your actions. But you must let it all go; no holding back on this one. If any stray negative thought enters in, and you indulge it and start mulling it over and open the door to it, your rejoicing will evaporate like a dove under the flick of a magician’s wand.
            When I think of Victoria now, and find myself sliding down into that black hole of melancholy and self-pity, I turn my focus instead to the wonderful memories of her and that pregnancy, and think ahead to the future, of being reunited with her for eternity. And in that thought alone I can rejoice mightily! I unconsciously smile, an automatic reaction to the happiness that creeps across my heart. My entire body bursts with joy over those thoughts. There is nothing sad about them.
            I’ll tell you a story that gives you an idea of the sense of humor God has.
            About ten years ago, Chris and I were struggling with work stress and life stress, both of which strained our marriage. Chris was having a particularly difficult time and ended up having to take doctor-ordered disability leave. Once again, I found myself at my rope’s end, not knowing where to turn, how to turn or when to turn. So one night I grabbed my Bible and retreated to our front porch rocking chair to cry out to God, to wallow in my agony.
            “Okay, God,” I sniveled, “I want to find a perfect psalm. One of those real heartrending ones David penned when he was at his wit’s end and felt abandoned and finished. Find me a real good one!” I flipped open my Bible to the Book of Psalms and stared at the words through blurry eyes. Tears dripped onto the page as I peered and squinted at the Psalm lying open before me.
            “What?” I whispered, mildly irked at the verses that leapt off the page at me. “No, God. That’s not what I was looking for! This is a praise and worship psalm, not one I can really sink my aching teeth into. What do you mean by leading me to this one?” After several seconds of pouting and internal argument, I murmured an “Okay, I’ll-read –it-but-I’m-not-going-to-like-it” response and dove in.
            As I read aloud the psalm of rejoicing and praise to God, my heart filled with love, understanding, forgiveness and peace. The words eradicated every ounce of sadness from my cells and caused my heart to pound with joy. Within seconds, my attention had flipped from focusing on all of my hurts, to how great and capable my God is. I actually felt a bit embarrassed and silly about my wallowing. For the next half-an-hour, I hugged my Bible close and thanked God for His wisdom and guidance, His loving, tender touch and redirection of my focus—from me and my doubts and human limitations, to His omniscient power to change my circumstances or guide me through them. Tears poured harder at the realization of His guiding hand. And then I laughed outright at the irony.
            He had taken me where I didn’t want to go, knowing that I needed to go there. 
            If you’ve never tried it, I encourage you to do so. Rejoice, even in the most difficult of circumstances. You’re not rejoicing about them, but you’re rejoicing through them. It will change your perspective.
            Pray without ceasing.
            This is pretty straightforward: Always be in an attitude of prayer, thoughtfulness, mindfulness (remember that post?), ready to hear God’s voice and leading. It makes you more sensitive to the Spirit and to His guiding hand.
            In everything, give thanks.
            I know. How does someone possibly do that given the agonizing pain and grief they’re mired in? The answer? You can’t. Not in your human flesh anyway. This is something where you need to surrender everything to God, and let Him do the thanking for you.
            In order to accomplish this, I usually say something along these lines, “Okay, Lord. Everything You do and allow to happen, You do for a purpose. So, please, let me learn what it is You have to teach me right here, right now. Don’t let me rebel against it; let me sink myself into it so I can learn all You have for me to understand.
            I remind myself (or try to) of the old Scottish adage that says, “The vine is never so close to the vinedresser as when it’s being pruned by Him.” The pruning hurts, but it’s oh, so necessary for the most prolific growth to occur. (More on this in a much later post.)
            And then there is the thanks I can give—and which renews my hope—at the reminder that God is still on the throne, He’s still in control, and prayer changes things. Sometimes what prayer changes is not the situation, but me, my attitude, my outlook. My heart. 
            So the main takeaway point is that there is always something for which I can give thanks. And giving thanks does wonders for my mind, body and soul!
            Pray the Scripture.
            This one isn’t in the list, but I have found it to be one of the most singly powerful ways to pray. Use Scripture to pray for yourself, your spouse, your children, your family and friends. God promises that His word will not return void unto him, so you can be assured that you are praying powerfully, in words that will be pleasing to God. Words that you can wrap around your heart and soul and soak yourself in. Words that will change you, inside and out.

            The bottom line is: Do NOT let anything or anyone steal your joy! Not even you! So often we give our joy away, or steal it from ourselves because we are so self-focused. That alone can keep us in bondage to depression and pain and rob us of the sound mind God wants us to enjoy.
            Good luck on practicing these principles. Please let me know how it goes!
            I’ll be praying for all of you!

NEXT WEEK: Relieving depression with manual therapy. The following week we’ll finish this series on beating depression with cognitive-behavioral therapy, and the first week in February, I’ll return to my story. You’ll want to join me for that, to read about the miracles, the internal struggles, the extreme battles with evil and spiritual darkness, the high-risk pregnancy, the joys, the losses, the angelic visit. All of it. It’ll be a story of redemption and joy you won’t want to miss.

Until next week,

Thanks for joining me!